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Biomedical subjects

E Ross

Publications and source records attributed to E Ross.

At least 37 records · Page 2Linked to original sources
PubMed2000

The current practices, training and concerns of a group of hospital-based speech therapists working in the area of dysphagia.

The aim of the study was to investigate the current practices, training, and concerns of a group of hospital-based speech therapists regarding the area of dysphagia practice. Questionnaires were posted to 75 speech therapists working in the major hospitals around Gauteng, Kwa-Zulu Natal and the Cape Province and responses were obtained from 50 therapists within the stipulated time. Closed-ended questions were analysed quantitatively using descriptive statistics, while open-ended items were subjected to content analysis of themes articulated by respondents. Results indicated that the overwhelming majority of the respondents were involved in assessing and treating dysphagia patients. Specific problems faced by respondents included limited staff to share their workloads, large caseloads, restricted access to supervision/mentor systems and poor knowledge by other health personnel of their role in dysphagia. Almost half of the respondents also reported that they were involved in student training which included the area of dysphagia. Investigation of respondents' undergraduate and postgraduate training in dysphagia suggested that there were gaps in the theoretical content of these courses as well as a limited focus on practical training. Another finding was that respondents showed an awareness of the specific roles of the speech therapist in dysphagia intervention as well as the roles of the professionals constituting a multidisciplinary dysphagia team. Most of the respondents reported that they had access to dysphagia team members as well as to diet modification services. However, many of the respondents showed decreased knowledge of and awareness regarding accessibility of diagnostic procedures and suctioning methods used in dysphagia. The majority of the respondents rated their knowledge about specific theoretical areas as well as their counselling abilities to be better than their actual skills and confidence in assessing and treating dysphagia patients. Implications of the study included the need for clinicians, universities and professional organizations to work together to improve the existing situation.

Deglutition Disorders↗
PubMed1999

The state of implantable pain therapies in the United States: a nationwide survey of academic teaching programs.

UNLABELLED: The purpose of this questionnaire survey was to provide an overview of anesthesiology pain fellowship programs in the United States with regard to implantation of spinal cord stimulators (SCS) and opioid infusion devices. Of the 95 programs solicited, 80% responded to questions pertaining to the prevalence of use and technical considerations of implantation. Of the responding programs, 87% report implanting SCS, and 84% report implanting neuraxial infusion pumps. All programs perform a stimulation or infusion trial before implantation, although the duration varied from a trial in the operating room at the time of implantation to 25 days. Of the programs, 83% implant cylindrical leads, and 17% implant flat leads via laminectomy for their nonrevision SCS implants. Morphine, bupivacaine, hydromorphone, and baclofen are the most commonly used drugs and are used in implanted pumps by >50% of respondents. The question of industry-sponsored pain fellow education in implantable techniques is addressed. IMPLICATIONS: Of the pain teaching programs in the United States, 80% responded to a questionnaire eliciting information about the implantation of spinal cord-stimulating and opioid infusion devices. The range and diversity of responses imply a lack of agreement about implantation techniques, drugs, and protocols.

Analgesics↗
PubMed1999

Vinblastine versus vinblastine plus oral estramustine phosphate for patients with hormone-refractory prostate cancer: A Hoosier Oncology Group and Fox Chase Network phase III trial.

PURPOSE: To compare vinblastine versus the combination of vinblastine plus estramustine as treatment for patients with hormone-refractory prostate cancer (HRPC). PATIENTS AND METHODS: A total of 201 patients with metastatic prostate cancer, progressive after hormonal therapy and antiandrogen withdrawal (if prior antiandrogen treatment), were randomized to receive vinblastine (V) 4 mg/m(2) by intravenous bolus weekly for 6 weeks followed by 2 weeks off, either alone or together with estramustine phosphate (EM-V) 600 mg/m(2) PO days 1 through 42, repeated every 8 weeks. Of 193 eligible patients, 98 received V, and 95 received EM-V. RESULTS: Overall survival trended in favor of EM-V but was not significantly different as determined by Kaplan-Meier analysis (P =.08). Median survival was 11.9 months for EM-V and 9.2 months for V. EM-V was superior to V for secondary end points of time to progression (P <. 001, stratified log rank test; median 3.7 v 2.2 months, respectively) and for proportion of patients with >/= 50% prostate-specific antigen (PSA) decline sustained for at least 3 monthly measurements (25.2% v 3.2%, respectively; P <.0001). Granulocytopenia was significantly less for EM-V compared with V (grade 2, 3, and 4 = 7%, 7%, and 1% v 27%, 18% and 9%, respectively; P <.0001); however, grade 2 or worse nausea (26% v 7%, respectively; P =.0002) and extremity edema (22% v 8%, respectively; P =.005) were more frequent for EM-V. CONCLUSION: Although overall survival was not significantly greater for the combination, EM-V was superior to V for time to progression and PSA improvement. These results encourage further study of estramustine-based antimicrotubule drug combinations in HRPC.

Administration, Oral↗
PubMed1999

Prostate cancer risk assessment program. A model for the early detection of prostate cancer.

Prostate cancer is the most common form of cancer (except skin cancer) in men. Several factors have been associated with an increased risk for prostate cancer, including age, ethnicity, family history, lifestyle, and environmental exposures. Recognition of the importance of the interaction of these factors in prostate cancer has led to an interest in their evaluation as a model both for studying genetic susceptibility patterns and for studying and providing educational tools and preventive interventions. One such model has been developed at Fox Chase Cancer Center. Critical to the implementation of the model has been the establishment of the Prostate Cancer Risk Registry (PCRR) and Prostate Cancer Risk Assessment Program (PRAP). Together, they serve as a unique resource for investigating the interaction between environmental factors and genetic susceptibility patterns; exploring the early, premalignant biological markers of prostate cancer; and prospectively assessing the quality of life (QOL) of men at risk. In addition, PRAP facilitates the evaluation of models for prostate cancer risk counseling and screening in the community. This paper describes this model for early detection and risk reduction, along with preliminary data from its first two study aims. The program is particularly relevant in view of the wealth of genetic information emerging from the Human Genome Project.

Humans↗
PubMed1999

Local excision and chemoradiation for low rectal T1 and T2 cancers is an effective treatment.

Lesions located in the distal third of the rectum are usually treated with abdominoperineal resection or a low anterior resection with a coloanal anastomosis. However, in a select group of patients with favorable histology and a low probability of lymphatic spread, sphincter-sparing procedures will afford long-term disease-free survival and cure without the need for extensive, complicated surgery. We performed a 10-year retrospective review, including pathologic examination of specimens by a single pathologist, in an attempt to identify factors associated with a decreased disease-free survival. Thirty-five patients (median age, 71 years; range, 48-88) with low rectal carcinomas were treated with full-thickness disc excision (with or without chemoradiation), with curative intent. Median follow-up was 46 months (range, 8-120). There were 15 T1, 16 T2, and 4 T3 lesions. Tumors with poor histologic factors or greater than T1 received adjuvant radiation (with or without 5-fluorouracil). Four patients developed a local failure at a median of 21.5 months (range, 9-30) and were salvaged with abdominoperineal resection. The 5-year cancer-specific survival was 91 per cent. Negative margins approached statistical significance (P < 0.07) in influencing local control. We conclude that, when combined with chemoradiation for lesions deeper than submucosa or with adverse histologic factors, local resection of rectal cancer is an effective treatment in selected patients.

Aged↗
PubMed1998

Epilepsy in young people: 23 year follow up of the British national child development study.

OBJECTIVE: To estimate the incidence and prevalence of epilepsy during childhood and early adult life in England, Scotland, and Wales. DESIGN: Prospective study of 17,414 children born in England, Scotland, and Wales between 3 and 9 March 1958, followed up at 7, 11, 16, and 23 years of age, with a review of those with epilepsy at age 28. SUBJECTS: People with epilepsy developing at or before age 23. MAIN OUTCOME MEASURES: The age specific incidence, cumulative incidence, and prevalence of epilepsy. RESULTS: 124 young people had a confirmed diagnosis of epilepsy during their first 23 years (cumulative incidence 8.4 per 1000; 95% confidence interval 6.8 to 10.0). 6 had died by age 23.46 (37%) had neurological impairment or another major health problem in addition to epilepsy. The prevalence of active epilepsy at age 23 was 6.3 per 1000 (4.9 to 7.7). CONCLUSIONS: A wide variety of seizure disorders is included under the term epilepsy. A third of cases had generalised seizures. In only a quarter was the onset of seizures attributed to a specific cause. Children with additional health problems were more likely to continue to have seizures in early adult life than those with epilepsy alone. 1 in 8 were prescribed drug treatment for 6 years or more after their last seizure. All deaths occurred in young adults over the age of 16.

Adolescent↗
PubMed1998

Prenatal and perinatal antecedents of febrile convulsions and afebrile seizures: data from a national cohort study.

The assumption is often made that brain damage during the perinatal period is likely to result in neurological abnormalities such as epilepsy and cerebral palsy. However, there has been accumulating evidence that cerebral palsy is rarely, if ever, a result of intrapartum events, but few studies of other neurological abnormalities have been undertaken. We analysed data on 16,163 children from the 1970 British national cohort study and followed to age 10, focusing on the 378 who developed febrile convulsions (FCs) and 63 children with idiopathic afebrile seizures (IAS). Children with IAS were significantly more likely not to have been breast fed (P < 0.001), and this was independent of features such as birthweight and maternal disorder. A similar finding was apparent for FCs (P < 0.05). Although children with low birthweight were at increased risk of both conditions, there was no association with maternal smoking in pregnancy. No associations were found between indications of fetal distress during labour and later febrile convulsions or afebrile seizures. There was no evidence that intervention during labour would have improved these outcomes. However, associations were found with abnormalities earlier in pregnancy, suggesting a prenatal rather than an intrapartum aetiology.

Adult↗
PubMed1998

A randomised placebo controlled trial of suppressive acyclovir in late pregnancy in women with recurrent genital herpes infection.

OBJECTIVE: To evaluate the efficacy and safety of a suppressive course of acyclovir in late pregnancy in women with recurrent genital herpes infection on the incidence of viral shedding, herpes lesion development and caesarean section for recurrent genital herpes. DESIGN: Double-blind, randomised placebo controlled clinical trial. SETTING: A department of genitourinary medicine in Sheffield and an antenatal clinic in London. POPULATION: Pregnant women with recurrent genital herpes infection at < 36 weeks of gestation. METHODS: Participating women were given acyclovir 200 mg four times a day (or matching placebo) from 36 weeks of gestation until the time of delivery. Women were seen weekly and viral cultures were obtained from the cervix and vulva. Decisions regarding mode of delivery were left to the discretion of the attending obstetrician. MAIN OUTCOME MEASURES: Delivery by caesarean section for recurrent genital herpes infection. Number of episodes of recurrent genital herpes infection and number of episodes of asymptomatic viral shedding during the treatment period. In addition blood was taken at two weekly intervals to determine acyclovir levels. RESULTS: The total number of women recruited was 63 (31 received acyclovir and 32 received placebo). The number of women undergoing delivery by caesarean section for recurrent herpes at the time of delivery was 12 (19%). The odds ratio for delivery by caesarean section in women taking acyclovir, compared with those taking placebo, was 0.44 (95% CI 0.09-1.59). The odds ratio for clinical recurrences during treatment was 0.10 (95% confidence interval 0.00-0.86) and the odds ratio for clinical recurrence or asymptomatic shedding during treatment was 0.32 (95% CI 0.05-1.56). CONCLUSION: This trial was unable to demonstrate that acyclovir can significantly decrease the number of caesarean section deliveries; however, the number of clinical recurrences was significantly reduced. Two episodes of asymptomatic virus shedding both occurred in women taking acyclovir. At the present time there is little evidence to suggest that acyclovir should be used outside randomised controlled trials for the suppression of recurrent genital herpes infection during pregnancy.

Acyclovir↗
PubMed1998

Phagocytic and tumor necrosis factor alpha response of human mast cells following exposure to gram-negative and gram-positive bacteria.

Recent studies have implicated rodent mast cells in the innate immune response to infectious bacteria. We report that cord blood-derived human mast cells (CBHMC) obtained from culture of cord blood progenitors phagocytozed and killed various gram-negative and gram-positive bacteria and simultaneously released considerable amounts of tumor necrosis factor alpha. Overall, the extent of the endocytic and exocytic response of CBHMC correlated with the number of adherent bacteria. Thus, human mast cells are intrinsically capable of mediating microbial recognition and of actively contributing to the host defense against bacteria.

Gram-Negative Bacteria↗
PubMed1998

Hepatitis B virus infection in patients attending a genitourinary medicine clinic: risk factors and vaccine coverage.

BACKGROUND: The hepatitis B virus (HBV) immunisation policy in the United Kingdom includes offering vaccines selectively to those at risk by sexual contact. Among genitourinary medicine (GUM) clinic attenders, homosexual men are offered vaccine, but estimates of the vaccine uptake are required to monitor policy and estimate the possible impact on transmission; heterosexuals are not routinely offered vaccine, but this policy might change if the prevalence was found to be high. OBJECTIVE: To determine the prevalence of HBV infection and vaccine uptake among patients attending a GUM clinic. METHODS: HBV seroprevalence determined by unlinked anonymous testing of consecutive blood samples sent for syphilis serology. Demographic and risk factor data and history of HBV immunization extracted from clinic notes before unlinking. Prevalence data were compared with a population of first time blood donors from the same area. SETTING: Open access GUM clinic in central London. RESULTS: Samples were obtained and tested from 441 homosexual and 527 heterosexual men and from 821 women over a 4 month period in 1990. After exclusion of injecting drug users and their sexual partners (n = 30) and HBV carriers attending for follow up (n = 12), the prevalence of antibody to HBV core (anti-HBc) was 38.7% in homosexual men, 5.9% in heterosexual men, and 3.5% in women (50.0%, 6.0%, 3.7% respectively if previous vaccinees were also excluded). The prevalence of HBV surface antigen positivity was 4.2%, 0.60%, and 0.39% respectively after exclusion of vaccinees (chi(2) p < 0.001 for homosexual men versus others). The prevalence of the anti-HBc in first time blood donors was 1.1% (8/749). Among male GUM clinic attenders, the prevalence of anti-HBc was higher in those of non-UK origin or place of birth and/or non-white ethnicity (odds ratios 2.87, 95% CI 1.57-5.24 and 8.06, CI 3.39-19.1, in homosexuals and heterosexuals respectively). In homosexual men anti-HBc prevalence increased with age (OR 1.05, CI 1.02-1.07 for each year) and lifetime number of STDs (OR 6.36, CI 3.77-10.8 for > or = 2 versus < 2) and in clinic reattenders compared with new patients (OR 5.42, 95% CI 3.32-9.16). Among heterosexuals, age was associated with anti-HBc prevalence in women (OR 1.09, CI 1.04-1.12) but not men (OR 0.99, 95% CI 0.95-1.02). There were no other associations in heterosexuals. A history of HBV immunisation in homosexual men was recorded in 13/131 (9.9%) of new patients and 103/305 (33.8%; OR 4.63, CI 2.49-8.60) clinic reattenders. CONCLUSIONS: Although higher than a sample of blood donors, the prevalence of serological markers of HBV infection among heterosexuals was low, providing little support for extending HBV immunisation to all heterosexuals attending GUM clinics as a targeted strategy for control of HBV infection. Homosexual men remain at high risk of infection, but many are now being immunised. Efforts to improve compliance with existing vaccine policies in GUM clinics should be encouraged.

Adult↗
PubMed1998

Mapping genes for NIDDM. Design of the Finland-United States Investigation of NIDDM Genetics (FUSION) Study.

OBJECTIVE: To map and identify susceptibility genes for NIDDM and for the intermediate quantitative traits associated with NIDDM. RESEARCH DESIGN AND METHODS: We describe the methodology and sample of the Finland-United States Investigation of NIDDM Genetics (FUSION) study. The whole genome search approach is being applied in studies of several different ethnic groups to locate susceptibility genes for NIDDM. Detailed description of the study materials and designs of such studies are important, particularly when comparing the findings in these studies and when combining different data sets. RESULTS: Using a careful selection strategy, we have ascertained 495 families with confirmed NIDDM in at least two siblings and no history of IDDM among the first-degree relatives. These families were chosen from more than 22,000 NIDDM patients, representative of patients with NIDDM in the Finnish population. In a subset of families, a spouse and offspring were sampled, and they participated in a frequently sampled intravenous glucose tolerance test (FSIGT) analyzed with the Minimal Model. An FSIGT was completed successfully for at least two nondiabetic offspring in 156 families with a confirmed nondiabetic spouse and no history of IDDM in first-degree relatives. CONCLUSIONS: Our work demonstrates the feasibility of collecting a large number of affected sib-pair families with NIDDM to provide data that will enable a whole genome search approach, including linkage analysis.

Age of Onset↗
PubMed1998

Living at home on a ventilator.

This study was undertaken to explore the perspectives of patients living at home on a ventilator. Understanding their perspectives could be helpful for planning education programs to prepare them for discharge as well as supporting them once they are at home. Analysis of audiotaped interviews with eight individuals revealed themes concerning skill in managing equipment, need for organization and planning, variations in necessary assistance, experiencing an emotional roller coaster, struggles with changing lifestyle, holding a positive attitude, the ventilator as an extension of self and preferences for the home environment.

Activities of Daily Living↗
PubMed1998

Attitudes of a group of primary school teachers towards the educational inclusion of hearing-impaired learners in regular classrooms.

Research has clearly demonstrated a link between the attitudes of regular education teachers and the success of inclusion of learners with special educational needs. Therefore, the present study aimed to investigate the attitudes of a group of junior primary school teachers from the Gauteng area towards the inclusion of hearing-impaired children into regular classes. A survey research design was employed which utilized a questionnaire as the research tool. Analysis of results indicated that the teachers surveyed were relatively positive in their attitudes towards inclusion. Greater exposure to disability in terms of training and experience was related to more positive attitudes. Similarly, more positive attitudes were related to greater perceived competence in teaching hearing-impaired pupils. All of the teachers surveyed felt that speech-language pathologists and audiologists (SLPs & As) should be involved in facilitating inclusion of hearing-impaired children. Many of the respondents expressed concern regarding their lack of training, knowledge and skills. The findings from the research project highlight the need for an adequate training and support system for teachers prior to the implementation of an inclusive educational policy, and the potential role of SLPs & As in this regard.

Attitude↗